Cardiac rehabilitation for patients with heart failure: association with readmission and mortality risk

Thygesen, L. C. et al. (2021) Cardiac rehabilitation for patients with heart failure: association with readmission and mortality risk. European Heart Journal: Quality of Care and Clinical Outcomes, (doi: 10.1093/ehjqcco/qcab086) (PMID:34850879) (Early Online Publication)

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Abstract

Abstract Aims To examine the temporal trends and factors associated with national CR referral and compare the risk of hospital readmission and mortality in those referred for CR versus no referral. Methods and Results This cohort study includes all adult patients alive 120 days from incident HF identified by the Danish Heart Failure Register (n = 33,257) between 2010 and 2018. Multivariable logistic regression models were used to assess the association between CR referral and patient factors and acute all-cause hospital readmission and mortality at 1-year following HF admission. Overall, 46.7% of HF patients were referred to CR, increasing from 31.7% in 2010 to 52.2% in 2018. Several factors were associated with lower odds of CR referral: male sex (odds ratio (OR): 0.85; 95% CI, 0.80-0.89), older age, unemployment, retirement, living alone, non-Danish ethnic origin, low educational level, New York Heart Association (NYHA) class IV vs I. (OR: 0.75; 0.60-0.95), left ventricular ejection fraction (LVEF) >40% and comorbidity (stroke, chronic kidney disease, atrial fibrillation/flutter, and diabetes). Myocardial infarction, arthritis, coronary artery bypass grafting, percutaneous coronary intervention, valvular surgery, NYHA class II, and use of angiotensin-converting enzyme inhibitors were associated with higher odds of CR referral. CR referral was associated with lower risk of acute all-cause readmission (OR: 0.92; 0.87-0.97) and all-cause mortality (OR: 0.65; 0.58-0.72). Conclusion Although increased over time, only one in two HF patients in Denmark were referred to CR in 2018. Strategies are needed to reduce referral disparities, focusing on subgroups of patients to be at highest risk of non-referral.

Item Type:Articles
Additional Information:This work was supported by The Danish Heart Foundation [grant number: 20-R145-A9654-22157].
Status:Early Online Publication
Refereed:Yes
Glasgow Author(s) Enlighten ID:Kober, Professor Lars and Taylor, Professor Rod
Authors: Thygesen, L. C., Zinckernagel, L., Dalal, H., Egstrup, K., Glümer, C., Grønbæk, M., Holmberg, T., Køber, L., la Cour, K., Nakano, A., Nielsen, C. V., Sibilitz, K. L., Tolstrup, J. S., Zwisler, A. D., and Taylor, R. S.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
Journal Name:European Heart Journal: Quality of Care and Clinical Outcomes
Publisher:Oxford University Press
ISSN:2058-5225
ISSN (Online):2058-1742
Published Online:30 November 2021
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in European Heart Journal: Quality of Care and Clinical Outcomes 2021
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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